Underkill
(1979)*
James White
Content
Chapter 1 ICU
Chapter 2 Complications
Chapter 3 Natural Resistance
Chapter 4 Case History
Chapter 5 Gunshot Wounds
Chapter 6 Multiple RTA
Chapter 7 Examination
Chapter 8 Consultation
Chapter 9 Bomb Blast Victim
Chapter 10 Comparative Physiology
Chapter 11 Special Treatment
Chapter 12 A Change Of Scenery
Chapter 13 Regimen
Chapter 14 Observation
Chapter 15 Police Operation
Chapter 16 Diagnosis
Chapter 17 Major Surgery
Chapter 18 Intensive Care
Chapter One
ICU
In spite of the advances in medical science and the sophistication of the associated bio-sensory and monitoring devices, the practice of intensive care therapy still required one highly-trained nurse concentrating all of her or his attention on one critically ill patient — staff availability permitting.
Tonight there was no shortage either of staff or patients, Malcolm saw as he left Ann inside the entrance of the Intensive Care Unit and walked slowly towards the glass-walled monitor room which, if he was lucky, he would not have to leave more than fifty times before the end of his current spell of duty. But as Malcolm looked at the bedside displays he passed, and at the clinical pictures they represented, he was afraid that he would not be even moderately lucky tonight.
In the monitor room the repeater screens with their more detailed presentations confirmed his fears.
"Anything unusual?" he asked Chiak, the day man.
"Not much," the other doctor replied, looking up at Malcolm with tired, red-rimmed eyes which were only partly concealed by the dozens of tiny monitor screens reflected in his spectacles. "Most of them are in the same condition as last night, hut not too stable, I'm afraid. There are three new arrivals, two RTAs and a GSW. One of the road traffic accidents should make it. The gunshot wound is in cubicle Four, in old Rawlins's spot. We lost him this afternoon." He yawned suddenly, showing a coated tongue and his not very good teeth, then added, "And there's a rumour that the Prof, will pay a visit sometime during the night."
"I'll he on my best behaviour," said Malcolm drily. Smiling, he went on, "This is not a considered medical diagnosis, you understand, but more in the nature of a friendly observation. You look ghastly, Chi. Even your glasses are bloodshot. Why don't you get out of this place for a few hours. Get some fresh air and exer —"
"Fresh air, in this city!" Chiak broke in. "And I could make a few friendly observations, too, and you are just going on duty. You look debilitated and ... Anyway, as a bachelor, I'm probably just feeling jealous."
"Probably," said Malcolm, smiling again. "But you should try for a change of scenery, even a brief one. Since your last promotion you rate a horse, four days in the month, for recreational travel. Next free day you could set off early and —"
"I can't drive the stupid beasts," said Chiak as he climbed stiffly out of his chair and walked towards the door. "Goodnight to you."
"Good-night," said Malcolm, taking the empty swivel chair. He tapped for the case histories, projecting the new admissions first and then the latest observations, taken since he had come off duty early this morning, of the other patients.
By the time he was finished Ann had taken over from the Day Sister and was assigning the night staff to their patients.
The cameras showed each changeover as it took place while the repeater screen displayed the tiny alterations in pulse rate and blood pressure caused by the brief presence of three people at the bedside instead of one. Sound pickups brought in the quiet voices of Ann and the relief and relieved nurses and, from every bedside whose occupant was not attached to a ventilator, the low, monotonous ramblings of patients talking endlessly to themselves.
Pain was something a patient was not allowed to suffer if it was possible to relieve it, and nowadays there were very few conditions where the associated discomfort could not be relieved, completely and utterly. But the painkilling drugs, and neomorph in particular, were closely allied to those used by the world's security organisations for the purpose of interrogation in depth. As a result the seriously ill patients, like the prisoners suspected of serious crimes, talked very freely.
The female overdose talked continually without making any sense, which was not surprising considering the amount and variety of medication she had swallowed in her efforts to end her life. Nobody knew why such a remarkably beautiful girl should want to do such a thing. She was almost certainly Upper level and, judging by the results of the immunisation tests, a traveller. But there was always a very good reason why a person decided that it was necessary to commit suicide ...
"Maybe there was no very good reason why she shouldn't," said Ann suddenly, speaking from behind him. "And you were talking to yourself again."
"There was nobody else to talk to," said Malcolm without taking his eyes from the monitors. "Expecting any problems tonight?"
"Nothing special," she replied, moving closer and indicating the screen which showed the multiple gunshot wound in cubicle Four. "Old Mr Hesketh, there, might not last the night, but again he could linger for a couple of days. He's seventy-three, and with thoracic injuries like that ... Anyway, he has a police guard who is hanging on his every word ..."
Malcolm tapped for an enlargement of the picture from Four, then studied patient Hesketh's face in close-up. Usually a security officer at the bedside meant one of three things — the patient was a VIP, he was an equally important criminal, or he was in possession of important information which he might divulge before termination. But it was obvious that tins patient was too fragile and undernourished to be considered either dangerous or very important by the authorities.
Hesketh had information, then, and it had to be very important information to warrant a police guard at his bedside rather than a simple request for the nurse in attendance to tape everything he said.
"... For some reason," Ann was saying, "the theatre did not do a tracheotomy, even though I'd say that he needed as much assistance with his breathing as we could possibly give him. So, no positive pressure ventilation. He can talk but he doesn't seem to be making sense. I think the guard is making him nervous."
"I can understand that," said Malcolm drily.
"As for your girl-friend here," she went on, tapping the picture of the overdose, "she is going to make it. But her nurse, Collins, says that in an hour or so the patient will require moral support and physical restraint, concurrently. Collins will need some extra muscle if the patient does the usual thrashing about, and she suggested that you would probably volunteer since you rarely pass up the chance of wrestling with a beautiful female."
"Nurse Collins," said Malcolm, "should have been a psychologist."
"Nurse Collins is a psychologist," said Ann firmly, "whether the hospital recognises the fact or not. Sometimes I wonder if this place knows how lucky it is in the quality of its staff. Most other hospitals are chronically short of staff while we get the very best available, seemingly from all over the world. And we are certainly getting more foreign patients than is usual."
"The price of fame," said Malcolm. "A good hospital attracts the best staff and the worst patients."
"Oh, be serious for a minute."
"All right," said Malcolm seriously. "What is worrying you? Communications or colour problems?"
"No," said Ann sharply, then smiled. "At least, not once I've learned how to understand some of the accents. But in this ward alone we have three African blacks, an Indian and a South American brown, a Japanese yellow among the nurses. If there was such a thing as a medically qualified green Martian we would probably have it, too. So no, it isn't their colour so much as the fact that they are all such highly trained people. Most of diem would rate Senior Sister in their home hospitals, and sometimes I'm not sure who has the rank."
"Surely they don't—"
"Of course they don't," Ann said quickly. "There is no insubordination, no criticism, no unpleasantness of any kind. But I can't afford to make a single stupid move with all that talent around, and I feel as if I'm spending my working life in the middle of a promotion exam."
Malcolm laughed and said, "When was the last time you made a stupid —"
The raucous buzzing of the attention signal made him break off. A red light was flashing on the cubicle Seven monitor but the patient's tell-tales, Malcolm noted, did not show any marked change in the clinical picture. His hand collided with Ann's as they both reached for the acknowledge button.
"Monitor room, Sister speaking," she said briskly.
"Caldwell in Seven," came the reply in an accent redolent of heather and the distant skirling of bagpipes. "This wee lad has pulled out his IV needle. I didn't think he had the strength. It isn't an emergency, but it's fair messing up the bedclothes. Will you tell the doctor, Sister?"
"I'm on my way," said Malcolm.
By the time he reached cubicle Seven, Nurse Caldwell had already shut off the intravenous flow, checked the bleeding and placed an adhesive patch over the former puncture.
"This won't hurt, Tommy," he said as he resited the cannula. Considering the hefty dosage of neomorph which was neutralising the discomfort of his multiple fractured arm and legs, whose plaster casts looked enormous on the boy's emaciated body, it would be surprising if he even felt the needle go in. Malcolm reconnected the IV tube and while the nurse was taping the needle in position, he went on gently, "You mustn't do that again, Tommy. If you make a habit of it we will have to put cot sides on the bed, as if you were a baby, and tie down your good hand. You aren't a baby, are you?"
The boy looked scandalised as he shook his head. He said, "Who ...you?"
Malcolm took a deep breath, held it while he removed his surgical mask, then smiled reassuringly for a moment before replacing it. He already knew that Tommy could not read so that II) patches meant nothing to him.
"Hello, Doctor Malcolm," the boy said, smiling back. "I'm sorry, I was dreaming about rats, and one of them bit my arm. Is Nurse mad at me?"
Nurse Caldwell shook her head very firmly and began replacing the stained top sheet.
"Of course not," said Malcolm. "But she would like you a lot better if you were to ask her for something to eat and drink. Tommy. I know you don't feel hungry, but that is because your stomach is very small and not used to much food. But you need food to help your broken arm and legs mend and to make you feel better generally. Do you understand that? And it's nice, clean food, like the Uppers eat. If you eat lots of it you won't need the IV tube and you won't dream of rats biting your arm. Just ask Nurse if there is anything you want."
The boy's large, brown eyes grew even larger and he blinked away tears as he said, "Mary. I want Big Mary."
"She'll come, Tommy," said Malcolm, "just as soon as she finds out where you are. Or we might be able to find her for you if we knew something about her."
Big Mary," said the boy drowsily as his mind slipped back into the neomorph-induced fog. "Big and soft and nice. Her face ... is nice ..."
Caldwell turned her eyes, the only features clearly visible above her mask, on Malcolm.
Defensively, he said, "There isn't anything I can do, Nurse, so don't look at me like that ... If he was ever given a surname he's forgotten it, and all she has to look for on the casualty lists is a juvenile RTA called Tommy. If she is able to read, that is. As for big, soft, nice Mary, what kind of description is that? How big is big to a skinny little runt so badly under-nourished that we can't place his age more accurately than somewhere between eight and eleven?"
Tommy had been unfortunate enough to be knocked down by one of the city's relatively few powered vehicles, and fortunate in that it had been an ambulance slowing to take a corner on its way to the hospital. He had been very lucky in receiving prompt and expert attention to his injuries sustained in an area of the city where road traffic accident cases, victims of muggings, rioting, and the unwanted very old or very young were left to lie and die until the waste reclamation Squads or a cannibal club removed them during the night. But the hospital could do nothing in the short term about the effects of living since infancy at subsistence level or below — the spindly, deformed limbs, the diseased and incredibly brittle bone structure and the irreversible damage sustained by his heart as a result of a number of severe bouts of rheumatic fever.
Despite his good fortune, young Tommy was expected to be a very short-term patient.
"It's difficult to be sure whether anything he says makes sense," Nurse; Caldwell said quietly. "But he did say that Big Mary followed John, and that she carried him like a wee bairn. That would mean that she's big, or strong, anyway. And she talks about climbing all the time. I have the strong feeling that she's a power walker."
"There are a lot of..." began Malcolm.
"I know, Doctor. But there is a police guard on Mr Hesketh. A policeman, if you asked him nicely, should be able to tell us how to find the one special power walker we're looking for."
Malcolm felt stupid for not thinking of that idea before Caldwell had, and he tried to hide his irritation as he said, "It's an idea. I'll ask him first chance I —"
He broke off as Ann's voice spoke from the cubicle's communicator. She said, "Sister here. Sorry to interrupt, Doctor, but the Professor has arrived with the night superintendent in tow. The overdose is coming to sooner than expected in cubicle Five, and Collins would like you to look at her as soon as possible. Mr Hesketh, the multiple gunshot in Four, is worrying Nurse Bandhu. Ectopics, blood pressure down and increased haemorrhaging.
"Is that all?"
"For the present," said Ann cheerfully. "If you would look at Mr Hesketh I'll keep the Prof, out of your hair while you're doing that."
There was nothing Malcolm could do except look at Mr Hesketh. The emergency admissions theatre had tried their best, but there was nothing that they could have done, either, for an old man who had stop...
Nashea2